达芬奇手术机器人系统对胃癌根治性切除术患者胃肠功能恢复及免疫功能的影响

Effects of Da Vinci surgical robot system on recovery of gastrointestinal function and immune function in patients undergoing radical gastrectomy for gastric cancer

目的:分析达芬奇手术机器人系统对胃癌根治性切除术患者围术期指标、炎性应激反应、免疫功能及术后并发症的影响。方法:选取医院收治的147例行胃癌根治性切除术患者,根据手术方式的不同将其分为机器人组(61例)和腹腔镜组(86例),腹腔镜组行腹腔镜下胃癌根治性切除术^(+)D_(2)淋巴结清扫术,机器人组采用达芬奇手术机器人系统行胃癌根治性切除术^(+)D_(2)淋巴结清扫术,比较两组围术期指标,炎性应激指标的C反应蛋白(CRP)和白细胞介素-6(IL-6)、免疫指标的T淋巴细胞亚群CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值及并发症情况。结果:机器人组总手术时间长于腹腔镜组,术中消化道重建时间短于腹腔镜组,术中淋巴结清扫数目大于腹腔镜组,差异均有统计学意义(t=2.788,t=3.157,t=3.172;P<0.05);机器人组术中出血量、术后首次排气时间、首次进食时间、引流量及引流管拔除时间均低于腹腔镜组,差异有统计学意义(t=3.101,t=4.791,t=4.199,t=2.307,t=2.630;P<0.05);机器人组术后1 d、3 d时血清CRP、IL-6水平均显著低于腹腔镜组同时间点,差异有统计学意义(t_(术后1 d)=2.390,t=3.415;t_(术后3 d)=4.825,t=5.582;P<0.05);腹腔镜组术后1 d和1周时CD4^(+)、CD4^(+)/CD8^(+)比值均低于术前,差异有统计学意义(t_(术后1 d)=2.387,t=4.221;t_(术后1周)=2.165,t=2.900;P<0.05)。两组并发症总发生率比较,差异无统计学意义。结论:达芬奇手术机器人系统用于胃癌根治性切除术患者,较传统腹腔镜手术可取得更好的近期疗效,且可减少患者炎性应激反应及免疫抑制,降低并发症风险。

Objective:To analyze the effects of Da Vinci surgical robot system on perioperative indexes,inflammatory stress response,immune function and postoperative complications in patients who underwent radical gastrectomy for gastric cancer.Methods:147 patients with gastric cancer who underwent radical gastrectomy for gastric cancer were selected and were divided into robot group(61 cases)and laparoscope group(86 cases)according to the different surgical methods.The laparoscope group underwent radical gastrectomy for gastric cancer under laparoscope^(+)D_(2)lymph node excision,and robot group adopted Da Vinci surgical robot system to conduct radical gastrectomy for gastric cancer^(+)D_(2)lymph node excision.The perioperative indexes,C-reaction protein(CRP)and interleukin-6(IL-6)of inflammatory stress indicators,CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)ratio of T lymphocyte subsets of immune indicators,and complications between two groups were compared.Results:The total operation time of robot group was significantly longer than that of laparoscope group(t=2.788,P<0.05),but the intraoperative reconstruction time of digestive tract of robot group was significantly shorter than that of laparoscope group(t=3.157,P<0.05),and the number of intraoperative lymph node excision of robot group was significantly larger than that of laparoscope group(t=3.172,P<0.05).The intraoperative blood loss volume,postoperative first exhaust time,first feeding time,drainage volume,and removal time of drainage tube in robot group were significantly lower or shorter than those in laparoscope group(t=3.101,t=4.791,t=4.199,t=2.307,t=2.630,P<0.05).The levels of serum CRP and IL-6 at the 1st d and the 3th d post operation in robot group were significantly lower than those in laparoscope group at the same time point(tpostoperative 1 d)=2.390,tpostoperative 1 d=3.415,t_(postoperative 3 d)=4.825,t_(postoperative 3 d)=5.582,P<0.05).The CD4^(+)value and the ratio of CD4^(+)to CD8^(+)in laparoscope group at the 1st day and the 1st week after operation were significantly lower than those before operation,and the differences of them between before and after operation were statistically significant(t_(1 day after operation)=2.387,t_(1 day after operation)=4.221,t1 week after operation=2.165,t1 week after operation=2.900,P<0.05),respectively.The difference of total incidence of complication between two groups were no significant.Conclusion:Da Vinci surgical robot system can achieve better short-term curative effect than conventionally laparoscopic surgery when it is used in patients who undergo radical gastrectomy for gastric cancer,and it can reduce inflammatory stress and immunosuppression,while do not increase the risk of complications.